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    Extubation versus tracheostomy in withdrawal of treatment-ethical, clinical, and legal perspectives.

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    Authors
    Chotirmall, Sanjay Haresh
    Flynn, Maura G
    Donegan, Ciaran F
    Smith, David
    O'Neill, Shane J
    McElvaney, Noel Gerard
    Affiliation
    Department of Medicine - Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland. schotirmall@rcsi.ie
    Issue Date
    2010-06
    MeSH
    Adult
    Beneficence
    Critical Care
    Decision Making
    Great Britain
    Humans
    Hypoxia, Brain
    Intubation, Intratracheal
    Male
    Personal Autonomy
    Professional-Family Relations
    Prognosis
    Quality of Life
    Tracheostomy
    Value of Life
    Withholding Treatment
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    Citation
    Extubation versus tracheostomy in withdrawal of treatment-ethical, clinical, and legal perspectives. 2010, 25 (2):360.e1-8 J Crit Care
    Journal
    Journal of critical care
    URI
    http://hdl.handle.net/10147/127210
    DOI
    10.1016/j.jcrc.2009.08.007
    PubMed ID
    19850443
    Abstract
    The provision of life-sustaining ventilation, such as tracheostomy to critically ill patients, is commonly performed. However, the utilization of tracheostomy or extubation after a withdrawal of treatment decision is debated. There is a dearth of practical information available to aid clinical decision making because withdrawal of treatment is a challenging scenario for all concerned. This is further complicated by medicolegal and ethical considerations. Care of the "hopelessly ill" patient should be based on daily evaluation and comfort making it impossible to fit into general algorithms. Although respect for autonomy is important in healthcare, it is limited for patients in an unconscious state. Beneficence remains the basis for withdrawing treatment in futile cases and underpins the "doctrine of double effect." This article presents a relevant clinical case of hypoxic brain injury where a question of withdrawal of treatment arose and examines the ethical, clinical, and medicolegal considerations inherent in such cases, including beneficence, nonmaleficence, and the "sanctity of life doctrine." In addition, the considerations of prognosis for recovery, patient autonomy, patient quality of life, and patient family involvement, which are central to decision making, are addressed. The varying legal frameworks that exist internationally regarding treatment withdrawal are also described. Good ethics needs sound facts, and despite the lack of legal foundation in several countries, withdrawal of treatment remains practiced, and the principles described within this article aim to aid clinician decision making during such complex and multifaceted end-of-life decisions.
    Item Type
    Article
    Language
    en
    ISSN
    1557-8615
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jcrc.2009.08.007
    Scopus Count
    Collections
    Beaumont Hospital

    entitlement

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